Provider Demographics
NPI:1376768408
Name:VICTOR V GAMMICHIA DDS PA
Entity Type:Organization
Organization Name:VICTOR V GAMMICHIA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:VITO
Authorized Official - Last Name:GAMMICHIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PA
Authorized Official - Phone:407-889-4868
Mailing Address - Street 1:450 ERROL PARKWAY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712
Mailing Address - Country:US
Mailing Address - Phone:407-889-4868
Mailing Address - Fax:407-889-7644
Practice Address - Street 1:450 ERROL PARKWAY
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712
Practice Address - Country:US
Practice Address - Phone:407-889-4868
Practice Address - Fax:407-889-7644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN51791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty